The efficacy and adverse reaction of bleeding of clopidogrel plus aspirin as compared to aspirin alone after stroke or TIA: a systematic review

PLoS One. 2013 Jun 20;8(6):e65754. doi: 10.1371/journal.pone.0065754. Print 2013.

Abstract

Background and purpose: Given the high risk of stroke after TIA (transient ischemia attack) or stroke and the adverse reaction of bleeding of antiplatelets, we undertook a meta-analysis, reviewed randomized controlled trials (RCTs) comparing aspirin plus clopidogrel with aspirin alone to determine the efficacy and adverse reaction of bleeding of the two protocols in the prevention of stroke.

Methods: We analyzed the incidences of stroke, bleeding and severe bleeding by using fixed-effect model or random-effect model on the basis of the result of heterogeneity test.

Results: Five qualified RCTs satisfied the inclusion criteria. We found that treatment with aspirin plus clopidogrel was associated with lower incidence of stroke (Risk Ratio (RR), 0.66, 95% confidence interval (CI), 0.47 to 0.93), higher incidence of bleeding (RR, 1.75, 95% CI, 1.48 to 2.05) as compared with aspirin-alone treatment. In terms of severe bleeding, no statistical difference existed between them (RR, 2.21, 95% CI, 0.25 to 19.52).

Conclusion: The combined use of aspirin and clopidogrel is more effective than aspirin alone for patients with previous TIA or stroke for the prevention of stroke, with risk of bleeding being higher. No statistical difference was found in severe bleeding between the two treatment protocols.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aspirin / adverse effects
  • Aspirin / therapeutic use*
  • Bleeding Time
  • Clopidogrel
  • Hemorrhage / physiopathology
  • Humans
  • Ischemic Attack, Transient / drug therapy*
  • Ischemic Attack, Transient / prevention & control
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Stroke / drug therapy*
  • Stroke / prevention & control
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin

Grants and funding

This work was supported by grants from the Program of National Natural Science Foundation of China (number 81070938), Program for New Century Excellent Talents in University (NCET-10-0406) and the Fundamental Research Funds for the Central Universities, HUST (number 2010JC028). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.